Age is an independent risk factor for increased morbidity in elective colorectal cancer surgery despite an ERAS protocol

Chan, Dedrick Kok Hong; Ang, Jia Jun; Tan, Jiajie; Chia, D.

doi:10.1007/s00423-020-01930-y

Cited by 18 publications

(9 citation statements)

References 36 publications

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“…Most of these interventions center on immediate preoperative, intraoperative, and postoperative practices. In aged patients who have lower baseline reserves, the emphasis will be countering the effects of sarcopenia to improve their physical, physiological, and functional reserves, allowing them to take on the stress of surgery 17,18 . Therefore, the concept of prehabilitation was conceived to achieve the abovementioned outcomes for patients who are due to undergo surgery.…”

Section: Introductionmentioning

confidence: 99%

Structured presurgery prehabilitation for aged patients undergoing elective surgery significantly improves surgical outcomes and reduces cost: A nonrandomized sequential comparative prospective cohort study

et al. 2021

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Background With increasing global life expectancy, the number of major surgeries performed on aged adults invariably increases. This study aimed to examine the effectiveness of a structured prehabilitative program for aged colorectal cancer patients in improving short‐term surgical outcomes. Methods A prospective philanthropically sponsored Programme for Enhanced Elderly Recovery at Sengkang General Hospital (PEERS) was initiated in February 2017 for patients ≥70‐years‐old who were due to undergo elective colectomies. These patients were put through a 2‐ to 4‐week‐long program before surgery, which included geriatric assessment, nutrition supplementation, and resistance training. They were compared with patients from a similar age group before PEERS was introduced (non‐PEERS). Results Fifty‐eight patients, with a median age of 78.5 (70–93) years, were recruited from a single institution to undergo PEERS. Baseline characteristics between the groups were similar. There was no significant improvement of anthropometric and functional characteristics before and after PEERS. Duration of hospitalization was shorter in the PEERS group (9 vs 11 days, P = 0.01). Both groups had similar 30‐days’ morbidity rates (8.6% vs 17.4%, P = 0.26). The PEERS group had significant improvement in their median EuroQol‐5 Dimension score (0.70 presurgery to 0.80 6‐months’ postsurgery, P = 0.01). After multivariate analysis, the average duration of hospitalization in the PEERS group was 6.8 days shorter (P = 0.018; CI, 1.2–12.4) after adjusting for modality of surgery and complications. This represented a cost saving of USD$11,838.80. Conclusion A standardized prehabilitation program for aged adults reduced the duration of hospitalization, improved the quality of life after surgery, and reduced costs.

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Section: Introductionmentioning

confidence: 99%

Structured presurgery prehabilitation for aged patients undergoing elective surgery significantly improves surgical outcomes and reduces cost: A nonrandomized sequential comparative prospective cohort study

et al. 2021

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“…Multivariate logistic regression revealed that age, female sex and more severe postoperative complications were independently related to prolonged LOS in short-level lumbar fusion surgery, following a previous study to some extent. 20 , 21 Regarding other risk factors, a rational interpretation for such an outcome was the distribution differences in the number of fusion levels. There were 51 (27.4%) patients with two fusion segments in control group and 51 (70.8%) patients in delayed group, leading to different operation and anesthesia times and the number of patients undergoing allogeneic transfusion.…”

Section: Discussionmentioning

confidence: 99%

The Potential Risk Factors for Prolonged Length of Stay Despite an Enhanced Recovery After Surgery Protocol for Elderly Patients Undergoing Short-Level Lumbar Fusion Surgery

Cui

Kong

Wang

et al. 2022

Geriatr Orthop Surg Rehabil

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Objective To identify the risk factors associated with prolonged length of stay (LOS) despite an enhanced recovery after surgery (ERAS) protocol in short-level lumbar fusion surgery. Methods We gathered data for all patients undergoing short-level lumbar fusion surgery from January to November 2021. Given the discharge criteria, a threshold was set according to mean LOS, and two groups were spontaneously formed: LOS shorter than the threshold for discharge (control group, n = 114) and LOS longer or equal to the threshold for discharge (delayed group, n = 72). Preoperative metrics were compared to identify risk factors associated with prolonged LOS. Results A total consecutive 186 patients with complete medical records were enrolled (77 males and 109 females; mean age 71.08 ± 5.70 years). After dichotomization according to the threshold for discharge, there were 114 patients in control group and 72 in delayed group. Statistical analysis demonstrated that age ≥75 years ( P = .002), female sex ( P < .001), American Society of Anesthesiologists grade ≥ 3 ( P = .035), operation time ( P < .001), anesthesia time ( P < .001), ambulation time >1 day ( P = .027), removal of urinary catheter time >1 day ( P = .019), fusion levels ( P < .001), Clavien-Dindo grade > 1 ( P <.001) and allogeneic transfusion ( P = .009) were significantly related to prolonged LOS. Binary logistic regression revealed that age (odds ratio (OR) 5.149; 95% confidence interval (CI) 2.045-12.966, P = .001), sex (OR 5.185, 95% CI 2.183-12.317, P < .001) and Clavien-Dindo grade > 1(OR 15.936, 95% CI 5.220-48.652, P < .001) were independent risk factors of prolonged LOS. Conclusions In this retrospective study, we analyzed the potential risk factors associated with delayed LOS despite implementing ERAS, further, binary logistic regression exhibited that age ≥75 years old, female sex and Clavien-Dindo grade >1 were independently correlated with prolonged LOS.

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“…There is good evidence showing resections can be safely performed in selected elderly people [12,13]. Compared with younger patients, older patients have a higher risk of morbidity and mortality after surgery [12,[14][15][16]. It is not proven if all elderly patients may be able to comply with the components of an ERAS ® program, or if they have better or worse outcomes with such programs than younger patients.…”

Section: Classification According To Phenotypic Characteristics: Olde...mentioning

confidence: 99%

Patient-Tailored Approach for Enhanced Recovery after Surgery

et al. 2022

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Background: Enhanced recovery after surgery (ERAS®) is increasingly finding its way into clinical practice. ERAS® protocols have not been universally adopted, and they have often been criticized for being difficult to implement. So, the question for more tailor-made approaches arises. Methods: We conducted a literature search on March 16, 2022, using the following search string, which was modified to fit the input of each of the queried databases: (“ERAS®” or “enhanced recovery after surgery” or “fast recovery” or “fast track”) and (“tailored” or “individual”). Results: Despite the massive increase in general hits on the subject, stratification according to phenotypic characteristics such as age or a classification according to disease patterns in the sense of specific guidelines is still fundamentally apparent. Evidence suggests that generic protocols can be followed by almost all patients. Prehabilitation, in particular, can be used as an adaptive tool. Conclusion: ERAS® works only in the totality of its tools and can be followed by almost all patients. Prehabilitation is more adaptive and can also increase adherence to ERAS® protocols. A tailored program outside of disease-specific pathways does not seem to be useful.

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Age is an independent risk factor for increased morbidity in elective colorectal cancer surgery despite an ERAS protocol

Cited by 18 publications

References 36 publications

Structured presurgery prehabilitation for aged patients undergoing elective surgery significantly improves surgical outcomes and reduces cost: A nonrandomized sequential comparative prospective cohort study

Structured presurgery prehabilitation for aged patients undergoing elective surgery significantly improves surgical outcomes and reduces cost: A nonrandomized sequential comparative prospective cohort study

The Potential Risk Factors for Prolonged Length of Stay Despite an Enhanced Recovery After Surgery Protocol for Elderly Patients Undergoing Short-Level Lumbar Fusion Surgery

Patient-Tailored Approach for Enhanced Recovery after Surgery

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